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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Firat A, Abbasoglu TT, Karcaaltincaba M, Balaban YH. Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview. World J Radiol 2023; 15:1-9. [PMID: 36721671 PMCID: PMC9884335 DOI: 10.4329/wjr.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.
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Affiliation(s)
- Aysegul Firat
- Department of Anatomy, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | | | | | - Yasemin H Balaban
- Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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Ramanathan S, Raghu V, Virmani V, Sheikh A, Al Heidous M, Tirumani S. Unveiling the unreal: Comprehensive imaging review of hepatic pseudolesions. Clin Imaging 2021; 80:439-453. [PMID: 34560516 DOI: 10.1016/j.clinimag.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
Hepatic pseudolesions are defined as non-neoplastic focal abnormalities of the liver which can mimic or conceal true liver lesions. It is particularly common in liver due to its unique dual blood supply and the existence of multilevel anastomosis between them. Because of the recent advances in CT and MRI technology, they are being increasingly encountered in daily practice. Broadly they can be categorised in to (1) Focal parenchymal abnormalities like focal fatty change, focal fat sparing, focal confluent fibrosis, segmental hypertrophy and regenerative nodules, (2) Perfusion abnormalities which include transient hepatic parenchymal enhancement in portal vein obstruction, third inflow, intrahepatic shunts, hepatic arterial occlusion and hepatic venous obstruction, (3) Imaging pitfalls like parenchymal compression, unenhanced vessels and pseudolipoma. It is essential for the radiologists to be familiar with the typical and atypical imaging features of pseudolesions to avoid mistaking them for sinister pathologies and also to avoid overlooking underlying hidden pathologies.
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Affiliation(s)
- Subramaniyan Ramanathan
- Department of Clinical imaging, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vineetha Raghu
- Department of Radiology, Columbia Asia Referral Hospital, Yeshwanthpur, India
| | - Vivek Virmani
- Department of Radiology, Dr. Everett Chalmers Hospital, Fredericton, Canada
| | - Adnan Sheikh
- Department of Emergency and Trauma Radiology, University of British Columbia, Vancouver, Canada
| | - Mahmoud Al Heidous
- Department of Clinical imaging, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar
| | - SreeHarsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, OH, USA
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Mohammadinejad P, Ehman EC, Vasconcelos RN, Venkatesh SK, Hough DM, Lowe R, Lee YS, Nehra A, Dirks S, Holmes DR, Carter RE, Schmidt B, Halaweish AF, McCollough CH, Fletcher JG. Prior iterative reconstruction (PIR) to lower radiation dose and preserve radiologist performance for multiphase liver CT: a multi-reader pilot study. Abdom Radiol (NY) 2020; 45:45-54. [PMID: 31705250 DOI: 10.1007/s00261-019-02280-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Prior iterative reconstruction (PIR) spatially registers CT image data from multiple phases of enhancement to reduce image noise. We evaluated PIR in contrast-enhanced multiphase liver CT. METHODS Patients with archived projection CT data with proven malignant or benign liver lesions, or without lesions, by reference criteria were included. Lower-dose PIR images were reconstructed using validated noise insertion from multiphase CT exams (50% dose in 2 phases, 25% dose in 1 phase). The phase of enhancement most relevant to the diagnostic task was selected for evaluation. Four radiologists reviewed routine-dose and lower-dose PIR images, circumscribing liver lesions and rating confidence for malignancy (0 to 100) and image quality. JAFROC Figures of Merit (FOM) were calculated. RESULTS 31 patients had 60 liver lesions (28 primary hepatic malignancies, 6 hepatic metastases, 26 benign lesions). Pooled JAFROC FOM for malignancy for routine-dose CT was 0.615 (95% CI 0.464, 0.767) compared to 0.662 for PIR (95% CI 0.527, 0.797). The estimated FOM difference between the routine-dose and lower-dose PIR images was + 0.047 (95% CI - 0.023, + 0.116). Pooled sensitivity/specificity for routine-dose images was 70%/68% compared to 73%/66% for lower-dose PIR. Lower-dose PIR had lower diagnostic image quality (mean 3.8 vs. 4.2, p = 0.0009) and sharpness (mean 2.3 vs. 2.0, p = 0.0071). CONCLUSIONS PIR is a promising method to reduce radiation dose for multiphase abdominal CT, preserving observer performance despite small reductions in image quality. Further work is warranted.
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Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Onur MR, Karaosmanoglu AD, Akca O, Ocal O, Akpinar E, Karcaaltincaba M. Imaging features of non-traumatic vascular liver emergencies. Jpn J Radiol 2017; 35:215-224. [DOI: 10.1007/s11604-017-0624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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Imaging Diagnosis of Splanchnic Venous Thrombosis. Gastroenterol Res Pract 2015; 2015:101029. [PMID: 26600801 PMCID: PMC4620257 DOI: 10.1155/2015/101029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach.
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Huang B, Geng D, Zhan S, Li H, Xu X, Yi C. Magnetic resonance imaging characteristics of hepatocyte apoptosis (induced by right portal vein ligation) and necrosis (induced by combined right portal vein and right hepatic artery ligation) in rats. J Int Med Res 2014; 43:80-92. [PMID: 25446177 DOI: 10.1177/0300060513503760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Using magnetic resonance imaging (MRI), this study aimed to demonstrate the appearance of hepatocytes following ligation of the right portal vein or combined ligation of the right portal vein and right hepatic artery, in a rat model. Methods Ninety adult Sprague–Dawley rats (body weight 250–300 g) were divided into three groups ( n = 30 per group): ligation of the right portal vein (Group A); combined ligation of the right portal vein and right hepatic artery (Group B); no intervention to obstruct blood supply (control group). Rats were then randomly subdivided into five groups that underwent examination at 3 h and 1, 3, 7 and 14 days postprocedure ( n = 6 per group). Livers were examined by routine MRI, diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS). After examination, each group of rats was sacrificed. Right hepatic lobes were removed and examined by pathology in six rats per timepoint; transmission electron microscopy (TEM) was undertaken in up to three rats per timepoint. Results Hepatocyte apoptosis and necrosis, by right portal vein ligation and combined right portal vein and right hepatic artery ligation respectively, were confirmed by pathology and TEM. In Group A, there were slight increases in intensity of T1- and T2-weighted images and in the apparent diffusion coefficient (ADC). In addition there were larger areas under the lactic acid and lipid peaks on MRS. In Group B, there were increased T1 and T2 signals, a decrease in the ADC and an increase of the area under the lactic acid peaks on MRS. Conclusions Hepatocyte apoptosis and necrosis induced by ligation procedures exhibited specific changes that were evident on MRI, DWI and MRS, and could be detected in vivo by MRI, in a rat model.
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Affiliation(s)
- Bingcang Huang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Songhua Zhan
- Department of Radiology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huanhuan Li
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaolan Xu
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Chunyan Yi
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
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